job satisfaction and retention among direct care workers
TRANSCRIPT
Walden University Walden University
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2021
Job Satisfaction and Retention among Direct Care Workers in Job Satisfaction and Retention among Direct Care Workers in
Times of COVID-19 Times of COVID-19
Emma Boone Walden University
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Walden University
College of Social and Behavioral Sciences
This is to certify that the doctoral dissertation by
Emma Boone
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Barbara Benoliel, Committee Chairperson, Human Services Faculty
Dr. Eric Youn, Committee Member, Human Services Faculty
Dr. Jeffrey Harlow, University Reviewer, Human Services Faculty
Chief Academic Officer and Provost
Sue Subocz, Ph.D.
Walden University
2020
Abstract
Job Satisfaction and Retention among Direct Care Workers in Times of COVID-19
by
Emma Boone
MA, Delta State University, 1997
BS, Jackson State University, 1991
Proposal Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Human Services
Walden University
November 2020
Abstract
Low employee satisfaction and retention have been identified as major challenges in the
American mental health workforce. High turnover rates and the growing demand for
direct care workers necessitates further research regarding satisfaction and retention. The
purpose of this generic qualitative study was to determine how direct care workers
employed by mental health organizations describe what motivates their satisfaction and
retention during the COVID-19 pandemic. Herzberg’s theory of job satisfaction was the
theoretical framework. Research questions explored job satisfaction and retention among
a group of 8 direct care workers. Semi-structured interviews were used to collect
participants’ perceptions of their work experiences. Data were analyzed using thematic
inductive analysis. Findings from the analysis indicate the importance of intrinsic
motivation and the role of extrinsic recognition as key in direct care worker retention.
Implications for social change include providing an understanding of job satisfaction and
retention of direct care workers to organizational leadership, managers, and trainers in
various mental health settings.
Job Satisfaction and Retention among Direct Care Workers in Times of COVID-19
by
Emma Boone
MA, Delta State University, 1997
BS, Jackson State University, 1991
Proposal Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Human Services
Walden University
November 2020
Dedication
I dedicate this doctoral study to my daughter whom I love more than life itself. She is the
best part of me and inspires me to be all that I can be. Throughout this journey, she has
been my constant. She is bold and beautiful, and intelligent beyond her years. I cannot
wait to see how she propels in life. Also, I dedicate my doctoral study in memory of
mom Alice Boone and my sister Cynthia Boone, who died on last year, just months apart
of each other. “Thumbs up ladies”, we did this”.
Acknowledgement
I would like to express my sincere appreciation to my chair, Dr. Barbara Benoliel, for her
support and encouragement. At my lowest point, she reminded me why I began this
journey and why I had to complete it. Thanks for being the soft voice with a strong
message. I would like to thank my committee members, Dr. Eric Youn and Dr. Jeffrey
Harlow, for your guidance at every stage of this research project. Without your insightful
comments and suggestions, I could not have reached my goal. I also express my sincere
gratitude to the faculty of Walden University for giving me the opportunity to become an
agent of social change. Finally, I would like to offer my special thanks to my brother
Lamar and my niece Jada who encouraged me from start to finish. I also appreciate the
“Boone”, family who always provided me with a much-needed distraction, thanks for
hanging in there with me, but most of all, thanks for the love and laughter. Without their
understanding and support over the years, this day would not have been possible.
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Table of Contents
List of Tables .............................................................................................................................v
List of Figures .......................................................................................................................... vi
Chapter 1: Introduction ..............................................................................................................1
Background ....................................................................................................................2
Direct Care Workers in Mental Health ..........................................................................3
Problem Statement .........................................................................................................5
Purpose of the Study ......................................................................................................5
Research Questions ........................................................................................................6
Theoretical Framework ..................................................................................................6
Nature of the Study ........................................................................................................9
Definitions of Key Terms ..............................................................................................9
Assumptions .................................................................................................................11
Delimitations ................................................................................................................11
Limitations ...................................................................................................................12
Significance of the Study .............................................................................................12
Summary and Transition ..............................................................................................13
Chapter 2: Literature Review ...................................................................................................15
Introduction ..................................................................................................................15
Literature Search Strategy............................................................................................15
Theoretical Foundation ................................................................................................16
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Herzberg’s Two-Factor Theory ...................................................................................16
Herzberg’s Theory in Use ............................................................................................16
Herzberg’s Variables ...................................................................................................17
Alternatives to Herzberg’s Theoretical Framework ....................................................19
Literature Review of Key Concepts .............................................................................21
Caring for the Mentally Ill ...........................................................................................21
Mental Health Workforce ............................................................................................21
Transcending Perspectives on Job Satisfaction ...........................................................22
Job Satisfaction among Mental Health Professionals ..................................................26
Job Satisfaction and Retention .....................................................................................30
Conclusion and Summary ............................................................................................31
Chapter 3: Research Method ....................................................................................................32
Introduction ..................................................................................................................32
Research Design...........................................................................................................32
Rationale ......................................................................................................................33
Role of the Researcher .................................................................................................34
Participants ...................................................................................................................34
Sampling ......................................................................................................................35
Informed Consent.........................................................................................................36
Confidentiality .............................................................................................................36
Data Collection ............................................................................................................37
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Data Analysis ...............................................................................................................38
Trustworthiness ............................................................................................................39
Summary ......................................................................................................................40
Chapter 4: Results……………………………………………………………………….43
Setting .………………………………………………………………………………43
Demographics.………………………… ……………………………………………43
Ethical Procedures ..…………………………………………………………………44
Data Collection ……………………………………………………………….……..45
Data Analysis ……………………………………………………………………..…46
Evidence of Trustworthiness ………………………………………………………..56
Results ……………………………………………………………………………….52
Themes …………………………………………………………………………...….52
Summary …………………………………………………………………………….58
Chapter 5: Discussion, Conclusions, and Recommendations ………………………………60
Introduction ……………………………………………………………………….…60
Interpretation of Findings ………………………………………………………....…60
Limitations of the Study ………………………………………………………….….64
Recommendations ………………………………………………………………..…..65
Implications ………………………………………………………………………..…66
Conclusion ……………………………………………………………………..….…75
References …………………………………………………………………..…..…...76
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Appendix A: Minnesota Satisfaction Questionnaire Survey .............................................83
Appendix B: Sample Job Satisfaction Questionnaire ........................................................84
v
List of Tables
Table 1. Description of Participant Demographics ............................................................43
Table 2. Example of Coding Process .................................................................................48
Table 3. Example of Coding Placement in Categories ......................................................49
Table 4. Inductive Development of Themes ......................................................................50
vi
List of Figures
Figure 1. Herzberg’s motivation/hygiene model ...............................................................12
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Chapter 1: Introduction
One of the largest growth sectors in the United States which is projected to be one
of the largest occupational groups by the year 2028 is direct care workers
(Paraprofessional Healthcare Institute [PHI], 2019). A subset of this occupational group
are direct care workers employed in mental health settings such as psychiatric hospitals,
residential mental health facilities, and related healthcare settings under the direction of
nursing and medical staff (Bureau of Labor Statistics [BLS], 2018). This occupation will
grow by 12% between 2018 and 2028 (BLS, 2018).
Direct care workers in the mental health sector can be interchangeably referred to
as psychiatric aides or behavioral or mental health workers. For this study, I referred to
them as direct care workers. This group of workers provide most of the hands-on care for
residents in mental health facilities. They perform tasks and assist residents with daily
living skills such as dressing and bathing, accompanying residents to and from
educational activities, medical appointments and other treatments, and restraining
residents to prevent harm to self or others (BLS, 2018). Further, direct care workers who
work with residents in mental health facilities may experience occupational stressors as a
result of changes in residents’ emotional states and unpredictable behaviors that can be
disruptive (Sailaxmi & Lalitha, 2015). These stressors may have been exacerbated by the
extra requirements of COVID-19 care.
With the projection of growth in direct care workers employed in mental health
settings and with the work environment challenges facing this work sector, understanding
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the motivators that are important to these workers could help strengthen this direct care
workforce and the organizations employing this workforce. This study examined
perceptions of the impact of intrinsic motivators that account for job satisfaction and
retention among direct care workers. Herzberg’s two-factor theory of motivation was
used to gain insight into perceived motivators that contribute to job satisfaction within
this mental health workforce.
The sections that follow include a background of the mental health workforce
with a description of direct care workers and problems faced in the mental health sector.
This includes the purpose of the study, research questions, theoretical framework, nature
of the study, definitions of key terms, assumptions, limitations, and the significance of
the study.
Background
A mental health workforce crisis exists in terms of the provision of treatment and
service delivery. An estimated one-third of the average ten million Americans with
mental illnesses receive no mental health treatment (Substance Abuse and Mental Health
Services Administration [SAMHSA], 2015). The mental health workforce has had issues
with shortages in staffing, maldistribution of providers, and challenging work
environments. Mental health workers are at high risk for burnout, which has a negative
effect on providers’ well-being, quality of services provided to their clients, and
organizations’ overall functioning (Green, Albanese, Shapiro, & Aarons, 2014). The
mental health system is faced with ongoing challenges in the delivery of services to those
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in need; correspondingly, the need for mental health workers in the United States
continues to increase (Beck, Manderscheid, & Buerhaus, 2018; Bukach, 2015).
Mental health workers experience high levels of burnout (Salyers et.al., 2015).
Goetz, Kleine-Budde, Bramesfeld, and Stegbauerr (2017) described work requirements
for mental health professionals as complex and highly structured, focusing on
collaborative interactions with multidisciplinary teams of providers. Mental health
workers experience work-related stressors such as high workload, lack of perceived job
control, and adverse work conditions that can lead to burnout, mental health issues,
physical issues, and intent to quit (O’Brien, et.al., 2018). Failure to retain employees
negatively impacts mental health organizations and overall performance (Bukach, Ejaz,
Dawson, & Gitter, 2015; Rose, 2016).
Employee job satisfaction and retention are linked and can be the result of various
conditions within and outside of the organization. Motivators such as the work
environment and perceived support from organizational leadership influence both job
satisfaction and employee retention decisions among direct care workers (Yoon et.al.,
2015). Holmberg, Caro, and Sobis (2017) said that nurses working in acute inpatient
settings identified their experiences of collaboration and close teamwork as significant
motivators that account for their job satisfaction.
Direct Care Workers in Mental Health
Within the context of a mental health workforce characterized by challenges in
the job and work environment as well as growth of the industry and constant shortages,
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direct care workers provide essential services for those with mental health issues. Direct
care workers in mental health represents one of the fastest--growing occupations in the
U.S., and their projected growth is 12% faster than all other occupations (BLS, 2019).
This group of workers is tasked with observing and reporting patients’ behaviors while
providing hands-on assistance with daily life skills including eating and bathing, as well
as restraining individuals who demonstrate physical violence (BLS, 2019). In all
healthcare settings but particularly mental health, the work of direct care workers is
essential to the lives of the individuals they serve, as they have considerable influence on
individuals’ wellbeing and treatment.
While direct care workers are critical to the daily operations of their
organizations, most are not unionized, and few are licensed health care providers. Despite
the work provided by these workers, compensation is much less than that of other
workers. The BLS (2018) reported the average income for this group of workers as
$11.57 per hour or $24,060 annually. Discrepancies do exist in the reporting of the
average rate of pay for these workers; however, the rate reported at its highest level is
still considered to be below the poverty line for a family of four.
While enduring work aspects that lead to burnout, direct care workers provide
care characterized by high physical demands, long work hours due to staff shortages, and
labor-intensive tasks which include lifting and restraining clients who may become
aggressive, often leading to high injury rates (BLS, 2019). Retention rates are low
(Bukach et al., 2015).
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Problem Statement
The mental health workforce in general is faced with many organizational
stressors that relate to job satisfaction and low retention of employees (Yoon et al., 2015).
These workers are faced with increased workloads that are both emotional and physically
demanding (BLS, 2018). Within this context, current and future demands for direct care
workers remains high (BLS, 2018; Kepley & Streeter, 2018), while retention rates are
low (Bukach et al., 2015). Failure to retain employees negatively impacts mental health
organization (Bukach et al., 2015) and organizations’ overall performance (Rose, 2016).
Job satisfaction has been linked to employee retention. However, I have not found the
nature and extent of such findings involving direct care workers in the mental health
sector. Further, employee motivation among direct care workers employed in mental
health organization remains understudied. A gap in literature exists regarding direct care
workers and perceived motivators that influence their job satisfaction and retention,
specifically during the period of COVID-19.
Purpose of the Study
This study addressed the work lives of direct care workers and perceived
motivators that may contribute to employee job satisfaction and retention. Herzberg’s
two-factor theory of work motivation was selected as the theoretical framework for this
study and used to determine perceived motivators that account for job satisfaction and
retention among direct care workers within the mental health sector. The purpose of this
generic qualitative study was to explore the perceptions of motivators that contribute to
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job satisfaction among mental health direct care workers. Mohamad and Leng (2018) said
that employee motivation is one of the driving forces that accounts for success of any
organization, and when motivated, human capital is said to function at its best.
Information from findings may be used to assist mental health organizations in improving
workplace practices that seek to improve satisfaction and increase retention of direct care
workers. These improved practices can assist mental health organization in stabilizing
this workforce by reducing employee turnover, which may in turn reduce the financial
repercussions of having to train new employees.
Research Question
The research question used to support my study is: What are lived experiences
and perceived motivators involved in job satisfaction and retention of direct care workers
in the field of mental health?
Theoretical Framework
Herzberg’s two-factor theory, first presented in 1959 and later amplified and
extended, was used to understand motivation to work. Herzberg (1966) said workers’ job
satisfaction is categorized into two domains: motivators (intrinsic) and hygiene
(extrinsic). Herzberg (1959) concluded that determinants of job satisfaction, which he
described as motivators, are different from the determinants of job dissatisfaction, which
he described as hygiene-related. Motivators satisfy workers’ needs for self-actualization
whereby organizations should seek to eliminate to prevent job dissatisfaction. This
research focused on intrinsic motivators that may lead to job satisfaction. Jobs that are
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perceived as interesting, meaningful, and enriching to employees contribute to job
satisfaction and motivation (Herzberg, Mausner, & Snyderman, 1959). Motivators
include promotions, achievement, responsibility, growth, and recognition (Herzberg,
1966). While motivation and job satisfaction are not considered to be interchangeable,
motivation is an essential element of job satisfaction (Herzberg, 1966).
Hygiene needs are the psychological and physical conditions under which
individuals work. The structure of the organization is an important hygiene factor, as are
characteristics within the organization such as physical working conditions, company
policies, job security, quality of supervision, salary, and employee relationships with
others (Herzberg, 1966). Hygiene motivators often determine levels of dissatisfaction
(Herzberg, 1966).
Herzberg (1959) suggested that motivator and hygiene factors are not opposites
but two different constructs. Herzberg et al. (1959) identified these factors as job
satisfiers (intrinsic motivators) which relate to the content of the job and job dissatisfiers
(extrinsic hygiene factors) which involve the job setting itself.
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Figure 1. Herzberg’s motivation/hygiene model.
Non-managerial workers employed in one of the largest private sectors in Jordan
believed that recognition of their opinions from their employers created a motivating
environment and increased their levels of job satisfaction (Alfayad & Arif, 2017). A link
between employee retention and job satisfaction is grounded in Herzberg’s two-factory
theory. Almaaitah, Harada, Sakdan, and Almaaitah (2017) articulated retention strategies
consisting of intrinsic and extrinsic factors such as employee recognition, workplace
conveniences, employer support, personal growth, and training opportunities. In my
study, Herzberg’s theory was used to assess the presence of intrinsic motivators that
could account for job satisfaction and retention of direct care workers. While Herzberg
(1959) suggested that organizational management should examine effective strategies
that employ both intrinsic and extrinsic motivators as a means of influencing employee
retention, my study involved focusing only on perceived intrinsic motivators.
MOTIVATORS:
Achievement, Recognition, Responsibility, Advancement,
Work itself and Growth
HYGIENE FACTORS:
Working Conditions, Salary, Status, Security, and
Interpersonal Relations
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Nature of the Study
This study involved a generic qualitative approach designed to provide an
understanding of perceived motivators that contribute to job satisfaction and retention. It
also provided participants the opportunity to share personal experiences from their
perspectives. Interpretations of participants’ responses helped construct meaning in terms
of what satisfies them to stay on the job.
Since it is not clearly understood which motivators lead to satisfaction and
retention of direct care workers, particularly in terms of challenges inherent in their jobs,
a generic qualitative analysis was used to assist in gaining an understanding of this
phenomenon. I conducted interviews during the data collection process that helped to
explicate perceived motivators that generate job satisfaction among this distinct group of
workers.
The sample population included direct care workers who are employed in mental
health organizations throughout Mississippi. These individuals are direct care workers
who provide hands on care for individuals who suffer from serious mental illnesses.
Participants were asked to respond to an oral survey. Recruitment strategies included
identifying eligible sites and posting flyers in public settings in areas where employees
met study criteria.
Definitions of Key Terms
The following key terms were used in this study:
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Analogous staff: Personnel employed as counselors, treatment specialists,
residential workers, therapeutic recreational specialists, caseworkers, case managers, and
employment counselors, all of whom have varying direct contact with clients in a helping
role (Packard & Kauppi, 1999). They are not considered to be direct care staff.
Direct care workers: Individuals who provide hands on care and personal
assistance in daily living to individuals with mental and/or medical disabilities or other
chronic conditions (PHI, 2013).
Extrinsic Motivators (Hygiene Factors): Factors such as physical working
conditions, company policies, job security, quality of supervision, salary, and
relationships with others (Herzberg, 1966).
Intrinsic Motivators: Factors that lead to positive attitudes toward jobs because
they satisfy needs for growth or self-actualization (Herzberg, 1966).
Job satisfaction: The positive emotional state a person feels
about his or her job (Frey, Bayon, & Totzek, 2013).
Motivation-hygiene theory: A theory involving motivators that cause job
satisfaction and dissatisfaction (Herzberg, 1987; Herzberg et al., 1959).
Peer Support Providers: Individuals with lived experiences involving psychiatric
disabilities who work to provide support to others with lived experiences (Cronise,
Teixeira, & Rogers, 2016).
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Retention: The length of time an employee stays on the job which is the result of
actions that business managers take to encourage employees to maintain employment
with their organization (Goud, 2013; Deeba, Usmani, Akhtar, Zahra, & Rasool, 2015).
Serious Mental Illness (SMI): SMI is a severe, chronic, and long-lasting disability
attributable to a mental impairment or combination of impairments such as schizophrenia,
bipolar disorder, or retardation (American Psychological Association [APA], 2013).
Assumptions
For this study, I made the following assumptions. First, that the survey questions
used will elicit reliable responses. The participants will fully understand the questions
being asked of them. Participants in the study were employed during the period of the
COVID-19 pandemic in residential centers .Participants in this study gave truthful
feedback that was useful for the study and had minimal concerns about sharing
information in an open forum.
Delimitations
The results of this study were restricted to direct care workers who currently work
in mental health organizations located in or near a metropolitan area of a southern state.
The decision to study populations and groups within this location was made because
there is a greater number of mental health organizations located in this area when
compared to rural surroundings locations. Although various organizations employ
paraprofessionals, the primary criterion for inclusion in this study was that respondents
provided direct care services to clients who receive treatment for a mental illness. All
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participants met criteria for inclusion into the study by working as direct care workers in
mental health facilities for a minimum of two years. Excluded from this study were
psychologists, psychiatrists, social workers, administrators, and other support staff
working in mental health organizations. Furthermore, the scope of this study was limited
to studying intrinsic motivators influencing job satisfaction and retention of direct care
workers within the mental health workforce during the period of COVID-19 pandemic
and is therefore not applicable to other time periods.
Limitations
This study involves Herzberg’s motivational factors, excluding hygiene
motivators that account for job dissatisfaction. Further, results may not be generalizable
to other direct care staff who perform similar health care duties as this study is limited to
direct care staff in mental health settings.
Significance of the Study
It is estimated that from 2018 to 2028, employment for individuals who provide
hands on care to those in need of psychiatric services will grow by 12% (BLS, 2018).
Direct care worker retention rates are low; with the growing demand for these workers,
recruiting and retaining them is critical for the performance of mental health
organizations in terms of treatment and delivery of those with mental health issues
(Hamstra, Van Yperen, Wisse, & Sassenberg, 2015). However, current research is
limited in terms of identifying motivators that contribute to satisfaction and retention
among this unique population of workers. This study involved perceived motivators that
13
contribute to job satisfaction and retention among direct care workers. Results could
benefit managers, supervisors, and policy makers as they seek insight into increasing
retention of direct care workers. Further, results could assist direct care workers in
choosing a career path that they are motivated to work toward.
Summary and Transition
There is a global shortage among mental health professionals, and such shortages
are detrimental to meeting the growing needs of the profession (Yanchus, Periard, &
Osatuke, 2017). Direct care workers make up an essential group of workers in the mental
health workforce but are often unnoticed. While workforce development approaches
often focus on degreed professionals in the mental health field, direct care workers
account for a vital part of the mental health workforce who are often stigmatized due to
the nature of their work.
To further strengthen this workforce, understanding perceived motivators that
contribute to their satisfaction and retention is critical. Using Herzberg’s theory of
motivation, I concentrated on discovering perceptions of motivators considered to be
determinants of job satisfaction that lead to the retention of direct care workers in the
mental health field. This will lead to positive social change by contributing to growing
discussions regarding mental health disparities of frontline staff with other mental health
staff in the U.S.
In Chapter 2, I provide a review of scholarly literature related to the mental health
sector. Information in this chapter includes unique characteristics of the workforce and
14
work environment in the mental health sector. Further, this section includes information
regarding the theoretical framework and motivators within the study that influence job
satisfaction and retention of the target population. In Chapter 3, I discuss the
methodology, data collection procedures, data analysis, and ethical implications.
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Chapter 2: Literature Review
Introduction
The purpose of this study was to explore perceived motivators experienced by
direct care workers and the impact these experiences have on job satisfaction and
retention. Herzberg’s two-factor theory was used to inform this qualitative study. This
literature review involved examining previous studies regarding job satisfaction and
retention within the general workforce and mental health sector. It also includes studies
of analogous mental health workers such as nurses, social workers, and psychiatrists.
Literature relevant to this current study involves human behavior within the workforce
and perceptions of how motivators serve as a driving force in job satisfaction and
retention within organizations.
Literature Search Strategies
I conducted a literature search using full-text databases including Academic
Search Complete, Medline, EBSCOHost, and Google Scholar. These databases allow
access to peer-reviewed journals, scholarly articles, and books. For my literature review
search, I used the following key words: job satisfaction, mental health workers, direct
care workers, recruitment and retention, direct care shortage, direct care
paraprofessionals, mental health, and motivation and employee turnover. I reviewed
peer-reviewed journals, dissertations, government publications, historical data, and other
published works regarding satisfaction and retention in healthcare systems and other
organizations.
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Herzberg’s two-factor theory was used to study the relationship between job
satisfaction and retention of mental health direct care workers. The purpose of this
generic qualitative study was to identify perceived motivators that account for direct care
workers’ job satisfaction and retention.
Theoretical Foundation
Herzberg’s Two-Factor Theory
Motivation factors and hygiene factors influence employee satisfaction. Hygiene
factors include salaries, job security, and quality of supervision while motivation factors
include interest in the vocation, prospects of career growth, and acknowledgment of
individual achievements. Different combinations of motivation and hygiene factors can
lead to situations where employees exhibit a high level of performance and are free of
complaints or situations in which they become chronic complainers (Karadağ, 2015). Job
satisfaction consists of two distinct dimensions: job satisfaction and job dissatisfaction
(Herzberg et al., 1959). The two-factor theory provides a mechanism for evaluating
satisfaction levels and clarifying how positive or negative employee outcomes occur.
Herzberg’s Theory in Use
Goetz et al. (2017) found that community mental health workers reported
motivators such as relationships with colleagues, increased job responsibilities, greater
recognition, and flexibility in terms of job tasks as contributing motivators that increased
their job satisfaction. Raza, Akhtar, Husnain, and Akhtar (2015) revealed that motivators
such as job security, achievement, responsibility, and the work itself were significantly
17
related to positive job satisfaction among these workers. Damij, Levnajić, Skrt, and
Suklan (2015) identified how aligning motivation with organizational strategies leads to a
satisfied workforce.
Motivators include challenging work, recognition for achievement, responsibility,
opportunities to do something meaningful, involvement in decision-making, and a sense
of importance to organizations (Ackah, 2015). The presence of these circumstances
serves as motivators when they are present in the workplace, but when not present,
employees are not necessarily dissatisfied (Herzberg, 1966; Herzberg et al., 1959).
Herzberg’s Variables
Achievement. When employees had motivators in their jobs, their job satisfaction
levels were higher (Sinha & Trivedi, 2014). Sinha and Trivedi (2014) found that patient
relationships (80.2%) and intellectual stimulation (69.7%) related intrinsically to the
work itself and ranked as the two most satisfying motivators among those practicing
medicine. Kang, Gatling, and Kim (2015) said that an employee’s career satisfaction
emerges from feelings of achievement due to the job itself.
Recognition. Employee recognition is another means of motivating employees
(Robescu & Iancu, 2016). Acknowledging an employee’s efforts is greatly appreciated
and could be instrumental in improving overall employee performance (Robescu &
Iancu, 2016). In support of this perspective, Shonubi, Abdullah, Hashim, and Hamid
(2016) examined perceptions of appreciation among IT employees in Melika. Findings
18
indicated that immediate recognition of employee efforts is one of the best ways to
inspire and strengthen commitment (Shonubi, Abdullah, Hashim, & Hamid, 2016).
The work itself. Herzberg et al. (1959) described work as the relationship of the
employee to the customer or group of customers inside or outside the organization. A
customer or a group of customers inside the organization is the employee of the
organization (Scheers & Botha, 2014). Mbogo (2016) examined the relationships among
spirituality, working conditions, and job satisfaction of 146 administrators and faculty of
extension studies from six selected Christian universities in Kenya. Mbogo found
significant differences between faculty personnel and administrators’ perceptions of their
global job satisfaction and their work. He discussed how educated personnel of extension
studies were more satisfied with their jobs than were their counterparts with less
education, in part due to differences in promotion opportunities; faculty were more
satisfied with their work globally and the actual work than were administrators, in part
due to differences in work responsibilities.
Responsibility. Employee responsibility within a job has four aspects: (a) self-
scheduling, (b) authority to communicate, (c) control of resources, and (d) accountability
(Herzberg, 1974; Herzberg et al., 1959). In self-scheduling, the client’s needs are more
important than employee needs (Herzberg et al., 1959; Herzberg, 1974). Empowering
employees plays a vital role in employees assuming and fulfilling assigned
responsibilities (Herzberg, 1974; Herzberg et al., 1959). Employers empower employees
19
by allowing them to have power, control, and authority within their jobs in the
organization (Efferin & Hartono, 2015).
Advancement. Employee advancement is linked to new learning; thus, training is
a significant factor in addressing employee growth needs (Herzberg, 1974; Herzberg et
al., 1959; Maslow, 1943). To be accountable within their jobs, employees must be trained
and equipped with appropriate resources (Herzberg et al., 1959). Noor, Khan, and
Naseem (2015) confirmed that job promotion and job advancement have positive
relationships with job satisfaction. Motivators such as flexible promotion policies, job
advancement, a reward policy that provides for equal opportunity to all employees, and
professional training for job improvement were contributing factors to job satisfaction
among the employees under study (Noor et al., 2015).
Alternatives to Herzberg’s Theoretical Framework
Herzberg’s original theory has been examined and criticized. Initially, the
theory’s underlying methodology was challenged as being too limited. House and Wigdor
(1967) said no empirical support for Herzberg’s theory exists and that Herzberg
oversimplifies the nature of job satisfaction. Further, methodological flaws have been
found (Ncube & Samuel, 2014 attempts to replicate Herzberg's findings have not
consistently supported the original study Bryan (2013).
Maslow’s work inspired many motivation theories. Maslow (1943) argued that
motivation needs are ordered in a hierarchy. Maslow identified five levels of need
consisting of, beginning with the lowest level: physical needs, safety needs, social needs,
20
esteem and achievement needs, and self-actualization needs. Lower level needs must be
satisfied first, or motivation will arise from the desire to satisfy the unmet need (Maslow,
1943). In work situations, Maslow’s need-hierarchy theory considered not only the need
for money to pay for necessities, but also psychological needs such as social, esteem, and
self-actualizing. As such, Maslow’s lower level needs overlap with Herzberg’s extrinsic
motivators.
McClelland’s needs theory. McClelland’s needs theory proposes that the work
orientation of most individuals is affected by three intrinsic needs: the need for affiliation,
the need for power, and the need for achievement. McClelland (1961) argued that
individuals with strong achievement needs are predisposed to react positively to work
environments where they are personally responsible for accomplishing difficult, but
feasible, goals and subsequently receive feedback about their performance (Rasch and
Harrell, 1989). The need for affiliation is defined as the desire for friendly and close
interpersonal relationships; the need for power is defined as the need to make others
behave in a way that they would not have behaved otherwise; and the need for
achievement as the drive to excel, to achieve in relation to a set of standards, to strive to
succeed (McClelland, 1961). This theory focuses on the motive to achieve.
Adams’ equity theory. Adams’ equity theory is one well-known process theory
which holds that individuals compare what they are getting from their job to that of
others, and if they perceive that they are getting less, their job satisfaction is affected. It
treats the employment situation as an exchange relationship of inducements/contributions
21
between an employer and employee. The employee’s contributions (inputs) are the things
one invests in the job. Inputs include any contribution to the exchange such as the amount
of effort put into the job, prior experience, training, and education. Inducements
(outcomes) are anything of value to the employee that he or she obtains from the job
situation. Inducements include getting adequate pay, receiving status from a position, and
making friends (Harpaz, 1983). Steers (1983) argued that Adams’ theory is perhaps the
most rigorously developed statement of how individuals evaluate social exchange
relationships
Vroom’s expectancy theory. Victor H. Vroom proposed a motivational theory of
job satisfaction based on the belief that people are motivated to achieve goals which they
deem as worthy. Vroom’s theory identifies three variables: valence, expectancy, and
instrumentality. Employees choose a level of performance (valence) that results in the
greatest reward; employees choose tasks that are within employees’ ability (expectancy);
and employees assume that the completion of given tasks will likely result in benefit to
the employees (instrumentality).
Literature Review of Key Concepts
Caring for the Mentally Ill
Living with a severe mental illness such as schizophrenia, bipolar disorder, or
depression has a debilitating impact on quality of life (Delespaul, 2015). Individuals who
suffer with serious mental disorders are no longer cared for in psychiatric hospital beds;
22
instead, they are cared for in long-term residential facilities or nursing homes (Torrey
et.al., 2015).
Staff shortages, a lack of training, and other occupational stressors are challenges
within the mental health workforce. Although considered one of the fastest growing
workforces in the country (SAMHSA, 2015), the projected outlook for employment in
this field remains grim. With the aging United States population, the need for a stronger
mental health workforce will soon be considered critical. The importance of these
alarming statistics is that access to mental health services is based on the number of
providers available to render the services needed (SAMHSA, 2015). When compared to
other areas of the healthcare workforce, disparities in the mental health workforce
between what exists today and what is needed in the future are far-reaching. As the
demand for mental health services increase, the shortage of mental health workers to
provide services and supports increases contributing to a gap in human resources and a
lack of training for individuals who work in the mental health care profession (Becker &
Kleinman, 2013). Factors such as high employee turnover present challenges to the
growth of any organization (Dong, Seo, & Barton, 2014) and with the growing demand
for mental health services, retaining talented workers is a vital component to workforce
success (Van Der Westhuizen, 2014).
Transcending Perspectives on Job Satisfaction
Employee job satisfaction has been studied extensively since the 1900’s; various
opinions exist as to what job satisfaction is and what motivators contribute to workers’
23
satisfaction and dissatisfaction in the workplace. Herzberg (1959) said that there are some
job factors that produce satisfaction and some others that prevent satisfaction. Herzberg
identifies hygiene factors such as pay, the work environment, company policy, etc., as
extrinsic motivators that can prevent satisfaction, with intrinsic factors known as
motivators such as recognition, responsibility and meaningful work are factors that
produce satisfaction (Herzberg, 1959).
Schneider and Snyder (1975) defined job satisfaction as a personal evaluation of
conditions present in the job, or outcomes that arise because of having a job. Job
satisfaction is based on the perception and assessment individuals form about their job.
Similarly, Locke (1976) said that job satisfaction is simply a pleasurable or positive
emotional state resulting from the appraisal of one’s job or job experiences. McCormick
and Ilgen (1980) regarded job satisfaction as individuals’ attitude towards their jobs but
described attitude as an emotional response to the job, which may vary along a
continuum from positive to negative. Harpaz (1983) suggested many people in
industrialized societies spend most of their day working, hoping that the job would be
both satisfying and challenging. When this does not happen, employees begin to feel
frustrated about the job; and their response to such frustration may be costly to the
individual, the employer, the economy, and society in general (Harpaz 1983). Similarly,
Sempane et al. (2002) suggested that job satisfaction involves employees’ emotions and
feelings. The level of job satisfaction will therefore have a major impact on employees’
personal, social, and work lives (Semppane et al., 2002), and influence their behavior as
24
employees, e.g. absenteeism (Locke, 1976; Visser, Breed & Van Breda, 1997). Collective
job satisfaction of employees may represent an organizational culture (Sempane et al.,
2002). Schultz and Schultz (1998) held that job satisfaction considers both positive and
negative feelings and attitudes people hold about their jobs and is based on many work-
related characteristics and personal demographics, such as age, gender, health and social
relationships. Arnold and Feldman (1986) described job satisfaction as “the amount of
overall affect that individuals have toward their job” (p.86). This would indicate that
individuals who are highly satisfied with their jobs tend to generate positive feelings
about their work. Within the many descriptions of job satisfaction, two perspectives are
captured. Job satisfaction entails overall feelings individuals have about their job.
Second, various aspects of the job such as the environment, rewards, and the actual
nature of the work contribute to or detract from feelings of job satisfaction.
Job satisfaction is one of the most frequently researched variables in investigative
and actual settings and has been extensively studied in organizational social sciences
(Yucel & Bektas, 2012). Job satisfaction has been associated with employee motivation,
behavior, and productivity (Dobre, 2013). Job satisfaction can refer to how a worker feels
about the work (Chughati & Perveen, 2013), or how an employee feels about the
workplace (Sypniewska, 2014). Both intrinsic and extrinsic motivators can increase
employees’ job satisfaction and improve their performance in the workplace (Edrak et al.,
2013). Saeed et al. (2013) defined job satisfaction as how much a worker enjoyed doing
the job, highlighting that many internal and external organizational motivators influence
25
employee job satisfaction, including working conditions, leadership, office politics, and
pay. Edmans (2012) examined the relationship between job satisfaction and an absent
employee. The correlation between those two motivators can assist the manager in setting
measurement and standards to recruit, retain, and motivate employees (Edmans). Edmans
(2012) indicated that an employer’s value to their employees promotes job satisfaction.
Job satisfaction includes all aspects of working within a company, even those things that
are not directly related to the work task itself (Awang, Amir, Osman, & Mara, 2013).
The relationship between job satisfaction and voluntary turnover has been the
most studied and documented subjects in the turnover literature (Government
Accountability Office, 2013; Lee, Burch, & Mitchell, 2014). Research suggests that job
satisfaction has a relationship to turnover and intentions (Habib, Aslam, Hussain,
Yasmeen, & Ibrahim, 2014). The most common finding is that there is a correlation
between job satisfaction and turnover, in which dissatisfied employees are more likely to
leave their jobs than employees who are satisfied (Khan, 2014; Sukriket, 2015).
Richardson (2014) found that when job satisfaction is high, motivation and performance
increase, while attendance problems and turnover decrease. Further, job satisfaction
predicts ways to decrease attendance problems (Richardson, 2014) and deter voluntary
employee turnover (Cho, Lee, Mark, & Yun, 2012; Diestel et al., 2014; Nobuo, 2014;
Richardson, 2014; Schmidt, 2014).
Job satisfaction can be a precursor of commitment (Panaccio, Vandenberghe, &
Ben-Ayed, 2014). Without the employee’s experience of job satisfaction, work
26
commitment decreases along with the employee’s commitment to the organization and its
objectives (Ridzuan, 2014). Omar and Ahmad (2014) identified job satisfaction and
organizational commitment as significant predictors of turnover intention.
These transcending perspectives on motivators that may lead to job satisfaction
have similar views to that of Herzberg’s. However, further research on these perceptions
is required to understand the influence of job satisfaction among direct care workers and
facets significant to the retention of direct care workers.
Job Satisfaction among Mental health Professionals
Having a broader knowledge of factors that lead to job satisfaction of mental
health professionals may help improve the quality and continuity of care provided by this
group of workers (Fleury, Grenier, Bamvita, & Farrand, 2018). A significant impact on
practices among mental health professionals is expected due to the ongoing efforts to
reform the mental health sector by providing improved funding and increased access to
care (Fleury, Grenier, Bamvita, & Farrand, 2018). Employees who experience high
levels of satisfaction are better motivated to work to support the efforts of their overall
team and in collaboration with other groups or organizations (Fleury, Grenier, Bamvita,
& Farrand, 2018). A review of the literature on different groups of mental health
professionals support Herzberg’s theory that job satisfaction is influenced by both
intrinsic and extrinsic motivators.
Job satisfaction among mental health nurses. The demand for mental health
services continues to increase, with an even greater need for strategies to recruit nursing
27
professionals (Holmberg, Caro, & Sobis, 2017). Nursing students tend to shy away from
mental health nursing because it is not as desirable as other career choices in the field
(Holmber, Caro, & Sobis, 2017). When looking at job satisfaction among nurses in the
field of mental health, researchers found that satisfaction for this group of employees was
motivated by the work itself, trust, good mutual communication among staff, and
interpersonal relationships with colleagues and patients (Holmberg, Caro, & Sobis,
2017). The authors conclude that having and understanding motivation and sources of
job satisfaction of nurses who choose to work in the mental health field is important for
workforce planning and in the efforts to recruit and retain nursing employees (Holmberg,
Caro, & Sobis, 2017).
Job satisfaction among mental health social workers. Social workers who
provide case management to individuals faced with serious and persistent mental illness
are faced with challenges inherent in the mental health sector and servicing clients
(Sullivan, Kondrat, & Floyd, 2015). The role of mental health social workers is
considered complex due to the population being served and the various services they
provide. Given the demands and challenges that come with the job, many social workers
are satisfied with both their work and the clients they serve. Sullivan, Kondrat, & Floyd
(2015) conducted a study among mental health social workers to examine factors that led
to job satisfaction and frustration and their impact on recruitment and retention of these
workers. Their study revealed that sources of satisfaction come from their direct service
to their clients, having flexibility with their job, and having the ability to design their own
28
work schedule. These findings are consistent with Herzberg et al.'s (1959, 1966) theory
that the work itself is a source of satisfaction.
Job satisfaction among psychiatrists and psychologists. Baumgardt, Moock,
Rossler, & Kawohl (2015) examined job satisfaction, cooperation, aspects of
sustainability, and burnout among Swiss psychiatrists. The findings indicated that job
satisfaction was generally high and burnout rates were below crucial values in the
dimensions of emotional exhaustion, and depersonalization (Baumgardt et al., 2015).
Intrinsic and extrinsic factors such as relationship with patients, autonomy, personal
rewards, and intellectual stimulation contributed to overall job satisfaction (Baumgardt et
al., 2015). Further, factors such as age and cooperation from patients were
sociodemographic and work-related characteristics that contributed to greater levels of
satisfaction (Baumgardt et al., 2015). Jiang et al. (2018) examined job satisfaction and
sociodemographic characteristics among psychiatrist in China. Findings revealed that
when compared to their counterparts, these psychiatrist experience a lower level of job
satisfaction due to factors such as their work conditions, salary, and security (Jiang et.al.,
2017). The findings from this study provide support for Herzberg’s theory of motivation.
Job satisfaction among direct care workers. Direct care workers, nursing
assistants and other frontline health care workers provide most hands-on care for patients
in mental health facilities and nursing homes, performing tasks to assist with their daily
living skills such as dressing and bathing. Given the nature of their work and the
29
increased demand for this group of workers, understanding factors that lead to their
satisfaction and retention could benefit the workers and their employers.
Limited research exists on studies that inform on job satisfaction among direct
care workers in mental health. Most literature about this group of workers is centered on
burnout and turnover. A dearth of research on direct care workers in general exists as
most research on satisfaction in mental health and general health care tend to focus on
professional staff. This disparity in research adds not only to the gap in knowledge on
satisfaction among these workers but also limits the knowledge needed in understanding
the motivational experiences that lead to satisfaction within the growing workforce.
Research findings indicate that both hygiene and motivators are relevant in
understanding job satisfaction and turnover among direct care workers. Low-wage
workers experience turnover which is likely to influence the quality of care provided
through: disruptions in the continuity of care, an increase in the number of inexperienced
workers, weakened standards of care, potential psychological distress for some patients,
and greater expense for the facility. The impact of turnover diverted funds from patient
care and increased workloads for remaining staff (Knapp & Missiakoulis 1983, Staw
1980). Caudill and Patrick (1989) said that staff who have emotional ties to residents and
are friendly with co-workers stayed longer. Grieshaber, Parker, and Deering (1995)
found that the quality of direct care workers’ social relationships with those for whom
they provided care had a significant effect on their satisfaction and turnover, concluding
that socializing with residents was considered the most satisfying aspect of the care-
30
giving job. Further, social support from family and friends helped to reduce burnout and
stress (Chappell & Novak, 1992). Gray and Muramatsu (2013) said that factors such as
work overload, role ambiguity, and lack of supervisory and coworker support were
sources of dissatisfaction that could contribute to intentions to quit. Gray-Stanley and
Muramatsu (2014) said that workers’ perception of common factors like day to day
routine contributed to stress and burnout.
Job Satisfaction and Retention
An employee’s job satisfaction leads to better job performance and retention
(Tehseen & Ul Hadi, 2015). Atchison and Lefferts (1972) found that job satisfaction had
an inverse relationship with turnover and absenteeism–that is, as job satisfaction
increased, turnover and absenteeism decreased. Lee, Miller, Kippenbrock, Rosen, &
Emory (2017) found that the work environment and institutional leadership were
presented as primary motivators in the satisfaction and retention of college nurses.
Relevance of the Study
The findings of this research carried out to understand the influence of intrinsic
motivation on the job satisfaction and retention of direct care workers is important to
organizations who employee these workers. Using the findings may be helpful to
organizations in developing and improving strategies for satisfying and retaining valuable
employees. Using these findings may also help to improve employee engagement thus
improving the growth of the organization. As such, the relevance of this study is its
potential contributions to organizational practice and implications for social change.
31
Conclusion and Summary
Chapter 2 began with the theoretical foundation of the research and how
Herzberg’s theory was used to inform past and present research as well as alternative
theories that explain job satisfaction. This was followed by key concepts in the field of
mental health and perspectives on job satisfaction and retention which included studies
that identified sources of motivators that lead to satisfaction among mental health
professionals including direct care workers. My review of the literature indicated that
research on motivators that lead to job satisfaction and retention of direct care workers is
underexplored. My study was used to fill this gap in knowledge through documenting
experiences of workers and exploring their perceptions of intrinsic motivators that may
lead to job satisfaction and retention.
32
Chapter 3: Research Method
Introduction
The purpose of this generic qualitative study is to explore the experiences of
direct care workers and perceptions of motivators contributing to job satisfaction. The
research question is: What are the lived experiences and perceived motivators involved in
job satisfaction and retention of direct care workers? Generic qualitative research is
useful for providing researchers the opportunity to explore opinions and world
experiences as well as participants’ self-reflections. My study involved exploring
experiences of satisfaction from the perspective of these workers. This chapter includes a
summary of the research methodology I used to guide the present study. I discuss the
research design and its justification. I also provided a rationale for further research
regarding this topic. I describe participants and the setting for research and outline
characteristics of the sample size and procedures. Subsequent sections include a
discussion of my role as the researcher, data collection and analysis procedures, validity,
and procedures I used for the protection of human participants.
Research Design
The experiences of direct care workers in mental health facilities are diverse. The
generic qualitative approach allowed me to explore perceived motivators that may
contribute to job satisfaction and retention among direct care workers. Use of this
approach enabled me to explore participants’ understanding of meanings they derived
33
from their motivational experiences. I explored participants’ subjective reflections of
their actual experiences within their work environment.
Using the qualitative approach allowed me to address the research problem by
exploring the lived experiences of these workers. I sought to gain an in-depth
understanding of motivational experiences of direct care workers in mental health and
how Herzberg’s intrinsic factors impact their job satisfaction and intent to stay with the
organization. This description of attitudes, experiences, and perceptions involving job
satisfaction and retention provided valuable data to help understand this phenomenon.
Rationale
The purpose of my study was to gain an understanding of participants’ lived
experiences about their work and how they are intrinsically motivated. A generic
qualitative approach was used to capture detailed and descriptive data regarding direct
care workers’ experiences; through thematic analysis, I gained clarity and an
understanding of their experiences. Participants in the study were given the opportunity
to share their individual perspectives about their satisfaction with work and personal
viewpoints in terms of why they remain in their profession and current organization.
I used a generic approach to understand the experiences of direct care workers.
The study highlighted Herzberg’s perceived motivators which include interpersonal
relations, achievement, recognition, work itself, responsibility, advancement, and growth.
The following research question was explored: what are the perceived motivators
involved in the job satisfaction and retention of mental health direct care workers?
34
Role of the Researcher
My professional experience includes working as a manager of multiple
psychiatric units, licensed clinician, and former direct care worker in the field of mental
health. With over 28 years of mental health experience, and having previously worked as
a direct care worker, I have insight into the phenomenon being studied. My roles in
leadership and paraprofessional positions including as a direct care worker have allowed
me to experience mental healthcare from various perspectives. As a former direct care
worker, I have experienced firsthand the conditions and responsibilities of direct care
workers.
As such, my experience increases the potential for researcher bias to exist based
on my personal interactions with direct care workers. For this study, I used myself as an
instrument. I conducted semi-structured open-ended interviews that allowed participants
to discuss perceptions and lived experiences working as direct care workers. Collins and
Cooper (2014) said that the role of the researcher is to gather information accurately and
report all data. My role as the researcher was to promote and maintain a balanced
dialogue between participants and myself by using questions related to the research topic.
I recorded all sessions to gather data.
Participants
Participants were selected based on their roles as direct care workers in the
mental health sector. Participants for this study worked in mental health facilities that
employed mental health direct care workers throughout the Metropolitan area of a
35
southern state. Recruitment began by placing flyers in local stores and restaurants near
organizations that employ these workers. Flyers contained specific criteria for
participation from the target population, guarantee of privacy, and contact information
(see Appendix C). I contacted relevant facilities within the area to gain permission to
recruit participants by posting flyers on their premises. Participants were selected based
upon specific work and tenure. Tenure qualifications required mental health direct care
workers to be employed by the mental health residential facility for 2 years or more. Two
years is the average length of agency commitment for direct care workers (BLS, 2014).
Sampling
Participants of this study were selected through purposive criterion sampling. For
this research, I chose purposive sampling because the participants criterion is compatible
with the study. Using purposeful sampling allows researchers to make a deliberate
selection of participants based on the qualities possessed to understand and enhance the
knowledge of the phenomenon under study (Etikan, Musa, & Alkassim, 2016).
Participants provided direct care services to children or adults in mental health facilities,
spoke English, and were able to read required informed consent forms.
The sample size for this study included eight participants. When using a
qualitative sampling strategy, smaller samples are used to gain a clear understanding of
the complexity, depth, variation, or context surrounding a phenomenon (Gentles, Charles,
Ploeg & McKibbon, 2015). A small sample of participants can be valuable, as a small but
highly informed sample can provide rich information about the topic (Percy et al., 2015).
36
In a study on understanding the lived experiences of satisfaction among Gen Y nurses, a
sample size of 10 nurses was used to assess job satisfaction and intent to stay (Anselmo-
Witzel, 2017). Use of a smaller number of participants provided in-depth perceptions of
direct care workers about the phenomenon.
Informed Consent
Prior to conducting the study, permission to proceed with my research was
obtained by Walden University IRB and other participating organizations. This
permission relies on adherence to various protocols such as informed consent. The
process for informed consent for the participants complied with ethical research
requirements. All participants signed an informed consent form and consented to be
audio taped which is in alignment with the Institutional Review Board (IRB) of Walden
University (see Appendix A). Participants were informed of the purpose of the study and
their rights as research participants. They were made aware of the fact that their
participation was voluntary and that they could withdraw from the research study at any
time without penalty or retribution. Risks posed to the participants were viewed as
minimal such as time away from other activities. It was estimated to take at least an hour
and a half to conduct the interview.
Confidentiality
Participant interviews along with the consent forms were coded for tracking and
record-keeping purposes. Only the consent forms had the actual names of the
participants; consent forms were placed in a secure file accessible to me only.
37
Participants were supplied with the researcher’s name, e-mail address, and contact
information. Participants were advised of their rights to request and receive a copy of the
results of the study or a summary of the results.
Participants were assured that their names or any other personal identifying
information would in no way be used or printed. This information was communicated in
a letter of informed consent when the actual interview took place. As with the informed
consent, the participants were informed that if at any time they felt uncomfortable, they
could discontinue the interview without fear of retribution. The participants for this study
were drawn from community-based mental health facilities.
Data Collection
During this unique period of time where face to face contact was limited,
electronic data collection using video conferencing was the primary method of collecting
data. This interview protocol involved incorporating a semi-structured interview
questions (Appendix B) that allowed for a broad range of opinions and reflections about
the real-life events experienced by this group of workers. In using this data collection
method, the primary focus was to extrapolate opinions and reflections of real-world
events about the experiences that lead to job satisfaction. In generic qualitative research,
the flexibility of using different methods allows researchers to achieve their research
objectives by using various methods that provide insight and understanding to the
research being studied (Lui, 2016). Once willing participants agreed to the study, I
described the purpose of the study and how the information gathered was used to identify
38
perceived motivators important to their job satisfaction. The interview was conducted in a
conversational dialogue by which I asked the questions and allow the participants to give
their responses based on their perceptions of their outer experiences.
In preparation to conduct the interviews using video conferencing, I was guided
by the survey questions in the Minnesota Satisfaction Questionnaire (MSQ-short-form),
to help validate that I asked the right questions to participants. Weiss et al. (1967) said
work fit is multifaceted and involves correspondence between the worker and their skills
as well as the reinforcements present in the work environment. The Minnesota
Satisfaction Questionnaire short form (MSQ)\, is a pencil-paper 20 item questionnaire
that uses a 5-point Likert scale response format to examine the level of job satisfaction.
The MSQ short form requires five minutes for completion and has the advantage of
measuring components of extrinsic and intrinsic job satisfaction.
Data Analysis
Data analysis is a major step in report writing as it entails the planning,
organization, transcribing, storing, analyzing and coding of the information gathered
from the research respondents. I reviewed the content of the interview and transcribed
the taped interviews. I used both audio and handwritten notes for the interviews to ensure
the highest level of gathering information from each participant. I recorded the date, time,
and location of each interview.
Analysis of the qualitative data began after the completion of each interview with
the participants. I used a thematic inductive approach to analyze the participants
39
responses to the interview questions. The questions used were designed to prompt
participants to share their experiences from their personal reflections. Responses from the
interview questions were then analyzed using a step-by-step inductive analysis process.
When analyzing the data from the study, I identified primary patterns in the data through
identifying themes and coded them as they related to job satisfaction and retention.
Following the first interview, I identified similarities in how other participants measured
their satisfaction. The process included identifying and labeling relevant words and
phrases in the transcripts. I then placed these repeated patterns into codes that assisted in
analyzing the information and guided the process of completing the identification of
codes.
Trustworthiness
An advantage of conducting qualitative research is the richness of the data
collected that is interpreted and coded in a valid and reliable manner. Trustworthiness of
the analysis is critical to the quality of qualitative research. A powerful strategy used to
ensure trustworthiness and support the credibility of the data is to explore the
phenomenon from multiple views. To achieve this, I used a qualitative approach to my
data collection method which enabled me to triangulate the results. To enable
triangulation, I gave close attention to how I interpreted the views of participants’
experience, used data collection strategies such as observation and field notes, and
reviewed relevant documents when reporting results. As the researcher, it was important
that I examined and triangulated multiple sources of data to address trustworthiness.
40
Transferability, conformability, and credibility are equally important when
reporting the results of content analysis (Elo et al., 2014). Techniques such as member
checks and peer review decrease the presence of researcher’s subjectivity in the findings
which is an important aspect of phenomenological research (Cilesiz, 2010). The
researcher must verify with the respondent groups the constructions that emerge from
data collected and analyzed. I conducted member checks throughout the interview
process to help improve the accuracy, credibility, and transferability of the study. I
conducted formal member checks in that I checked for accuracy of information by
summarizing the response received from participants and sharing the relevant summary
with each participant. Maintaining transparency is another important element of
phenomenological research. Transparency allows readers to understand the process by
which the findings of the study are produced and interpreted, providing an audit of
decisions related to the research (Cilesiz, 2010). I performed a detailed content analysis
and then shared the findings and the final draft, so that readers can assess the validity of
the research and comment on the findings. Further, I ensured that the results of the study
were applicable to the organizations in which the study took place (Shenton, 2004).
When presenting the data, I assured each participant the opportunity to have an equal
voice.
Summary
In this section, I focused on the research design and methodology for the study. I
41
used a generic qualitative approach that identified experiences and perceptions involving
satisfaction and its impact on retention among direct care workers. I outlined my role of
the researcher and the format I used to assist participants in terms of sharing their
perceptions and experiences that lead to satisfaction. I described how the design allowed
me to identify and gain insights into motivating factors that could contribute to job
satisfaction and increased retention. Further, I identified proposed participants for the
study and sampling procedures along with data collection and analysis tools. Finally, I
discussed the importance of trustworthiness during the research process. In Chapter 4, I
present the results of the study.
42
Chapter 4: Results
This chapter contains the results of the generic qualitative study conducted to
answer the primary research question: What are the lived experiences and perceived
motivators involved in job satisfaction and retention of direct care workers? In this
chapter, I used a generic qualitative study approach with data gathered from in-depth
interviews with direct care mental health workers. This chapter also details participants’
demographics. The process used to analyze transcripts from the eight individual
interviews involved coding and thematically categorizing the data. There were three
levels of analysis: open, selective, and theoretical coding. During each level of analysis,
constant comparison was used until themes emerged from the data. Included in the
chapter are data as well as summaries of from interviews used to emphasize key themes.
This chapter concludes with a summary of findings as they relate to the research
question.
Setting
Due to COVID-19, each interview took place over the phone. During this data
collection process, several participants had to reschedule their initial interview dates or
times due of work-related issues attributed to the pandemic. Those who rescheduled
reported that due to the pandemic, they were asked to work longer hours due to a
shortage of direct workers. Participants selected the day and time that was most
convenient for them. Participants were contacted at home, but I called each participant
from my office to avoid interruptions. Each participant was interviewed over the phone.
43
The environment was quiet and posed little interference in terms of my ability to
transcribe recorded interviews. The average length of each interview was 45 minutes. No
other conditions interfered with participation in the study.
Demographics
All participants in the study were African Americans between the ages of 21-55.
Participants were a group of eight direct care workers currently working in mental health
settings throughout a metropolitan area of a southern state. Participants consisted of
three females and five males. Age demographics, gender and setting are reported below
(see Table 1).
Table 1
Demographics of Participants
Participant Gender Age Setting
1 M 50-64 Community Mental Health
2 F 26-49 Mental Health Hospital
3 M 26-49 Mental Health Hospital
4 F 50-64 Mental Health Hospital
5 M 18-20 Mental Health Hospital
6 F 26-49 Community Mental Health
7 M 26-49 Mental Health Hospital
8 M 26-49 Mental Health Hospital
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Ethical Procedures
To ensure ethical compliance during the research process, I adhered to the IRB
protocols to guide this research project. I included in the consent form my approval
number 06-17-20-0310981 with an expiration date of June 16, 2021. Ethical research is
important when collecting rich data to understand the phenomenon being studied. As the
researcher, I was accountable for the protection of human rights of participants,
guarantees of confidentiality, and addressing any ethical concerns. Yin (2018) said that
when soliciting voluntary participation for research, each participant should be given an
informed consent form which advises them of their rights and the nature of the study. In
addition, I followed Belmont Report protocol to ensure that participants had a clear
understanding of their rights as participants in the study. Participants were informed of
risks involved in the research as well as their right to discontinue their participation at
any time. Due to COVID-19, consent forms were emailed to participants detailing
research procedures such as the nature of the study, risks, privacy, benefits, and contact
information. Participants were required to respond via return emails with a typed
statement of consent stating, “I consent to participate in the study” prior to their
interview. I also used an audio recorder to make it easier to focus on the interview
content and assist with notes. Each interview was recorded on an audio recorder, and
participants were informed of the recording both in the consent form and orally prior to
the start of the actual interview.
45
Data Collection
Prior to the start of my research, I obtained permission from business owners near
areas that employed direct care workers. Owners were accommodating and offered to
post flyers themselves. I also posted announcements on LinkedIn. For this study, semi-
structured interviews were the primary data collection source for narrative data. I served
as the primary data collection instrument. DeJonckheere and Vaughn (2019) said semi-
structured interviews are commonly used in qualitative research and are a primary source
of qualitative data in health services research. Participants were eight direct care workers
working in the field of mental health. Because of the COVID-19 pandemic, interviews
took place over the phone with direct care workers who work and live in metropolitan
area of a southern state. Prior to the study, consent forms were emailed to each
participant and each participant responded. Participants were invited to answer a set of
open-ended questions guided by a flexible interview protocol that I supplemented with
follow up questions, probes, and comments in keeping with recommended interview
practices. Interviews varied from 45 minutes to an hour (see Appendix A).
I interviewed participants using open-ended questions and used active listening
skills to help them feel comfortable sharing their stories. I also used probing to allow
participants to draw out rich and detailed descriptions of their experiences. All interviews
were recorded, and participants seemed to have put thought into their responses to
questions. Upon interviewing eight participants and finding no new data, saturation
occurred. Once saturation was achieved, no additional data were collected. Moser and
46
Korstjens (2018) said that data saturation is achieved when information becomes
redundant and participants have provided enough information about the topic under
study. As participants reflected on their personal experiences and beliefs, there
similarities in terms of responses. Data went through triangulation to ensure findings
remained consistent. Each participant seemed forthcoming and comfortable sharing in-
depth experiences and beliefs about their work. Conducting semi-structured interviews
that included interview questions and probing assisted in prompting deeper reflections for
participants and provided unique findings.
Data Analysis
At the conclusion of the interviews, I transcribed each interview and prepared the
transcriptions for data analysis. According to Sundler, Lindberg, Nilsson, and Palmér
(2017), thematic analysis aims at gaining an understanding of the meanings of patterns
from the data from lived experiences. In the analysis of data, I engaged in a step-by-step
analysis. I reviewed the content of the interview questions and manually transcribed the
recorded interviews. After the completion of each interview, I began analysis by
identifying patterns, themes, and dimensions in the data. My initial process of analysis
included listening to each taped interview several times to ensure accuracy in reporting
the data. I highlighted and identified statements with similar messages, and assigned a
descriptor based on the intrinsic factors under study. While reading the data, I created
codes and looked for additional themes and patterns to emerge. Responses from
participants were then analyzed using a step-by-step inductive analysis process. The goal
47
of the analysis was to identify meaning of patterns as described by participants as they
share their experiences in their own words. I utilized the following steps to perform the
thematic analysis:
1. I reviewed recordings and all interview transcripts; highlighted sentences and
phrases that seemed meaningful based on the key terms in the literature and in
the framework.
2. I reviewed the highlighted data and determined if the highlighted data was
relative to the research question.
3. I coded each item of data with a descriptive word.
4. I then connected the data to develop patterns.
5. I defined properties of the themes.
6. I created categories that represented the themes and looked for subthemes
7. After all data was analyzed, I arranged themes to correspond with supporting
patterns.
8. I wrote a detailed analysis describing the scope and the theme.
9. After the analysis, I described each and elucidated by supporting quotes from
the data.
10. I then combined themes together to form a composite synthesis of the research
questions being studied.
After listening to the audio recordings multiple times and transcribing the
interviews, I identified a list of codes, then established which code was related to, or
48
addressed the research questions. I then grouped the codes into categories that reflected
the themes based on the theoretical concept of intrinsic rewards.
Table 2
Example of Coding Process
Raw Data Code
“I know I’ve done a good job when my
patients shake my hand and thank me
when they are being discharged”
Client feedback
“No opportunities exist if you don’t have
college hours”
Stagnated
“I’ve been on the job for almost 25 years
and received the recognition in my later
years”
Acknowledgment
“I’m responsible for making sure my
patients and co-workers are safe”
Ensuring safety
“The work itself is challenging and can be
unpredictable because this is mental
health”
High performing workforce
49
Table 3
Example of Code Placement into Larger Categories
Codes Categories
• Client Feedback • Relationship with clients
• Reaching goals
• Praise from clients
• No Career Growth
• Feeling limited based on education
and experience
• Limitation of Training and
development
• Stagnated
• High performing workforce • Work Environment
• Challenging work
• Difficult tasks
• Uncertainty
• Lack of acknowledgment
• Getting good responses from
leadership
• Appreciation from leadership
Some key coding that emerged from the data were helping others, relationships
with others, commitment, and contentment with a job well done (see Table 4)
50
Table 4
Inductively Developed Thematic Categories
Research Questions Thematic Category Summary
What do you value most about
being a DCW?
Achievement
Each participant expressed how their
relationship with and positive feedback
from their clients is what they value most
about working as a DCW.
What are your experiences or
opportunities in seeking
advancement on your job
In what ways are you
recognized as a valuable
employee?
What responsibilities do you
have in your role as a direct
care worker?
What are some of the day to
day experiences in working as a
DCW?
Advancement
Recognition
Responsibility
Work-itself
Overall, participants referred to
advancement for DCW’s as being
limited to job experience and lack of
education.
Participants described how recognition
programs highlighted their job
commitment.
Each participant seemed to view their
greatest responsibility as ensuring the
safety and care of their clients.
Each participant described the work
itself as challenging when staffing is
short, unpredictable due to the client’s
illness, but rewarding because they can
help people in need.
Evidence of Trustworthiness
Credibility, dependability, confirmability, and transferability are the key focus in
terms of trustworthiness of data analysis (Eli et.al., 2014). Participants were identified
51
based on their age, gender, and the number of years they worked in mental health as a
DCW. To ensure credibility in describing the participants lived experience, I recorded
each interview and took detailed field notes to help report rich and thick descriptions of
experiences conveyed by the participants. At the end of each recording, I listened to the
content for a minimum of 3 to 4 times for accuracy in transcribing the interviews
verbatim. I then transcribed the interviews, highlighting and underline meaningful
content. To ensure dependability, I carefully documented and followed a step-by-step
process to code the data. I organized the data and group the information into categories.
The categories were used to identify themes. To ensure accuracy of the transcripts, I
double checked the transcripts with the audio recordings. I transcribed and kept field
notes, followed my interview guide, I used codes to identify themes, and I secured the
files of each participant. To address confirmability, I journaled following each interview
and made notes of words or phrases that stood out during the interviews. I also made
notes of my thoughts on details such as reasons participants gave for rescheduling as it
related to working conditions and the pandemic. To guarantee transferability, I reviewed
the transcripts and verified that each response aligned with the recorded interview. I then
provided readers with evidence that the sample participants possessed the knowledge and
experience that fully represented their field and that the information they provided w
meaningful to the topic under study.
52
Results
Raw data best captured participants’ perceptions of how intrinsic factors impact
their job satisfaction and retention. In this generic qualitative inquiry, open-ended
interview questions were used for guiding each participants response to the same
sequence of questioning. Using open-ended questions provided me the opportunity to
avoid steering respondents in a particular direction when responding to the questions, and
instead gave each direct care worker an opportunity to present reliable and valid
information based on their lived experience.
There was a consensus among the participants that the bond with their clients and
the appreciation received from client feedback was perceived as achievement. All
reported having a meaningful relationship with their clients and a sense of satisfaction
with their work performance which also was supported by the clients’ responses. The
bonding relationship between the participants and their clients tend to resemble that of a
family commitment.
Themes
The themes that emerged from the guiding questions are summarized and
identified based on intrinsic rewards of (a) achievement, (b) advancement, (c)
recognition, (d) responsibility, and (e) work itself. The quotes from participants are used
to support the perceptions of the data collected during the interview.
53
Theme 1: Experiences with Achievement
Participants perceived their relationship with their clients as the greatest measure
of achievement. Each participant reported having developed a strong bond with their
clients and that they “looked forward” to assisting clients and providing their day to day
needs. Most cited a genuine concern for ensuring the safety and wellbeing of their
clients as their achievement. Participants also described their achievement in terms of the
good feedback they received from the clients and family members they cared for.
Participants described their achievements with the following statements:
“I know I’ve done a good job when my patients shake my hand and thank me when they
are being discharged”.
“My patient always tells me how he appreciates the time I take out to just sit and talk
with him”.
“My greatest achievement and what I value most about being a direct care work is caring
for people in need and hearing them say “I did a good job”.
“I cared for a patient until he died, and I felt good for being able to do that”.
To summarize the theme that emerged from the data in relation to achievement,
the research question asked, “What do you value most about being a DCW”?
Participants described how taking care of their clients was meaningful to them and what
meant even more was feedback from their clients that indicated a job well done. The
client-staff relationship seemed to have made a significant impact on their achievement.
54
Theme 2: Experiences with Advancement
Many participants described their experience with as advancement as limited due
to a lack of education and years of experience. Some participants voiced a sense of
contentment with their jobs even though they believed that advancement opportunities
were limited. Three of the eight participants reported having participated in training that
allowed them to advance to supervisory positions over fellow direct care workers, while
others felt that there was no real opportunity provided for advancement. One participant
reported being on the job for at least five years with no opportunities to advance, and
others confirmed similar statements.
Comments included:
“There’s not too many opportunities for promotions or raises in this role”.
“I really don’t want a promotion because I work a shift that allows me to do other things
like go to school”.
“No other opportunities exist if you don’t have some hours of college”.
“Because of my education, I am at the height of my career but my years of experience
made it possible to advance to the point of a direct care supervisor”.
“You can sometimes move up if you go to training, but it’s still direct care work”.
To summarize the theme that emerged from the data in relation to advancement,
the interview question asked, “What are your experiences or opportunities in seeking
advancement on your job”? Overall, participants experienced limited to no significant
55
training for opportunities to advance. Nevertheless, this experience did not appear to
change their sense of commitment to the job or the organization.
Theme 3: Experiences with Recognition
In addressing the theme that emerged from recognition, participants offered
statements regarding their recognition. Most believed that their organization had
standard recognition programs for all employees, and few were directed to direct care
workers specifically. One participant highlights a recognition program geared directly to
direct care but believed that over the years, effort placed in the program had diminished.
The participants gave the following examples:
“I was recognized for both employee of the month, and employee of the year”.
“I’ve been on the job for almost 25 years and received the recognition in my later years”.
“The Employee Recognition Program recognizes the years on the job but not the work we
do”.
“I seldom attend the recognition program due to shortage of staff and an inability to leave
my assigned post”.
“We’re not really appreciated”.
“My clients recognize the work that I do, and that’s enough for me”.
To summarize the participants response to being recognized as a valuable
employee. Most seemed to view recognition programs as adequate while others
expressed a dissatisfaction with administration due to the lack of recognition, they felt
deserved. Interestingly, each participant in the study had been recognized as employee of
56
the month at some point in their career. Participants also reported not feeling valued by
their supervisors or hospital administration and seemed to have placed more value on the
recognition they received from their clients.
Theme 4: Experiences with Responsibility
Most participants described their primary responsibility as taking care of and
meeting the needs of the clients. Participants who had supervisory roles felt responsible
to both the staff and clients in their care. Participants seemed to have a deep sense of
accountability to the clients and appeared to prioritize their clients care over any
additional responsibility they had.
Participants stated the following:
“Making sure my clients daily needs are met such as dressing, bathing, and getting them
ready for appointments, is a responsibility that has not changed in my twenty years
working here”.
“As a supervisor, I’m responsible for the staff, their schedule, daily assignments, and
making sure staff take care of their assigned clients”.
“ I’m a responsible person in general, but my biggest responsibility at work is to make
sure my patients and co-workers are safe and I’m committed to coming to work “day
after day”, “year after year” and “hanging in there”.
To summarize the theme that emerged from the data in relation to responsibility,
the research question asked, “What responsibilities do you have in your role as a DCW”?
Participants pointed out that their primary responsibility was to the clients they served.
57
This included but was not limited to assisting them with activities of daily living,
ensuring their safety, and being present to make sure the other activities take place.
There was also co-worker responsibility whereby most believed that showing up and
working as a team was important to the outcome of ensuring a safety work environment
for everyone on their service.
Theme 5: The Experience of Work itself
When describing some of the day to day experiences in working as a direct care
worker, participants described their job duties as providing hands on assistance to clients
with daily skills like bathing, eating, going to appointments, and observing their behavior.
Most participants shared similar experiences about work overload, having a challenging
and unpredictable work environment, and working short. Participants believed that their
work was considered routine practice given the environment and role that they work in.
Participants stated the following:
“Taking care of patients when you’re short of staff is hard, but the work has to get done”.
“The work itself is challenging and can be unpredictable because this is mental health”.
“I feel even more valued being able to succeed in performing a difficult task”.
“I take special care in making sure my clients are shaved and dressed properly every day
and that’s the one thing I really like about my work, and it gives them a sense of pride in
how they look”.
To summarize the emerging theme of the work itself, it was found that most
employees experience challenging times due to shortage of staff, high turnover, and
58
unpredictable clients who suffer from a mental illness but require hands on assistance and
monitoring from these workers. Despite this, participants stressed the importance of
doing the best at their jobs. Statements such as these demonstrates the value participants
place in the work they do.
Participants also described their current experiences with work due to Covid-19.
Most described the working conditions as even more stressful for similar reasons like
“work overload and shortage of staff” however, they now attribute the fear of contracting
the virus as a cause for even more concern. Only one participant voiced concern about
the lack of protective gear and believed that it was a major reason why “half the staff are
out”, whereas the majority of the participants described having adequate PPE supplies but
were more concerned about social distancing with clients who require hands on
assistance with most of their needs.
Summary
Participants in this study described the importance of their client relationships,
which appeared to be a much better indicator of their job satisfaction and retention when
compared to other rewards They described challenges involved with the job such as
work overload due to staff shortage and limited career advancement. Participants’
perceptions of bonds with their clients seem to show the presence of intrinsic motivators
that lead to both job satisfaction and retention.
Chapter 5 includes the findings from the study and how the study relates to the
current body of literature regarding job satisfaction and retention among direct care
59
workers in the field of mental health. Also included in Chapter 5 are limitations of the
study, recommendations for future research, and implications for positive social change.
60
Chapter 5: Discussion, Conclusions, and Recommendations]
Introduction
I conducted this generic qualitative study to answer this research question: What
are lived experiences and perceived motivators involved in job satisfaction and retention
among direct care workers in the field of mental health? Participants in the study were
direct care workers who currently work in mental health organizations located in the
metropolitan area of a southern state. Participants responded to semi-structured interview
questions involving themes based on Herzberg’s intrinsic rewards. In this chapter, I
present an interpretation of findings, limitations, recommendations for future studies, and
implications for social change.
Interpretation of the Findings
Participants mentioned intrinsic rewards such as recognition, sense of
achievement, opportunity for advancement, and the work itself contribute to job
satisfaction and retention of direct care workers who work in mental health settings.
Participants identified achievement in terms of the work they performed and the
positive feedback they received from their clients. Most reported having developed strong
bonds with their clients and looked forward to caring for them. One participant stated,
“When I cared for a patient until he passed was the time when I felt most satisfied.”
Khanna (2017) said that employees experience a sense of achievement when their job
duties reflect their capabilities and allow them to maximize the use of their skills and
talents. Participants in the study expressed a sense of value in the way they performed
61
their jobs under challenging conditions. Khan, Waqas, and Muneer (2017) said intrinsic
rewards fulfill employee motivation and are characterized by factors such as performing
challenging tasks. Participants said that their duties and responsibilities to clients
contributed to their commitment. They expressed that a job well done was their definition
of achievement.
Data also showed that employees believed that advancement opportunities were
limited due to their lack of education and work experience outside of direct care.
Improving these opportunities would lead to a greater sense of satisfaction and retention.
Another participant said, “I always look for ways to better myself on the job so that I can
move up, but the opportunities are just slim to none.” Khan et al. (2017) said job
advancement leads to long term satisfaction of employees and promotional opportunities
are vital to employee engagement. Promoting employee engagement is challenging;
however, organizations are realizing the importance of providing adequate training and
building meaningful work environments intended to encourage employees responsible for
providing meaningful contributions to the organization. According to Momanyi and
Kaimenya (2015), lack of employee training and development opportunities result in
inadequate promotion and career advancement, which in turn leads to turnover intention
of employees.
The outcome of an organizations failure to implement strategies that transcend
into intrinsic rewards could be detrimental to any organization. Allam (2017) said that
employees not fully engaged in their work can generate negative relationships with job
62
satisfaction, commitment, and retention within organizations. Osborne and Hammoud
(2017) said employees who experience intrinsic rewards such as dedicated and
meaningful work are more likely to recognize their value within the organization, which
in turns fosters increases in employee engagement.
Participants highlighted what they perceived to be meaningful work despite
inadequate training and opportunities for promotion. This again highlights the importance
of recognition among these participants. A primary determinant of raising job
satisfaction and morale is recognizing employees’ good performance.
The findings of the study suggest that recognition is important to most
participants; however, most believed that recognition efforts within their organizations
were inadequate. To improve their satisfaction and retention, participants suggested
recognizing employees for their hard work, not only in terms of their years of
commitment but for the work they performed. Khan et al. (2017) said that recognizing an
employee’s performance through verbal praise or even an informal pat on the back has
been proven to boost employees’ self-esteem and happiness, which results in contributing
efforts that lead to satisfaction. Ensuring a sense of appreciation among employees using
tangible rewards such as bonuses, achievement certificates, and prizes in the presence of
their coworkers have all been indicators that support employee retention (Khan & Qadir,
2016).
Participants also shared experiences involving challenges inherent to working in
the field of mental health, such as responsibilities for caring for clients diagnosed with a
63
serious mental illnesses, work overload due to staff shortages, and unpredictable work
environments, yet despite these factors, they found value in terms of ensuring the safety
and care of their clients.
Participants also reported that the absence of certain work conditions made it
difficult for workers to stay. They identified concerns that may contribute to turnover
such as shortage of staff in general, especially during COVID-19. One participant said
that the “administration is not getting patients who test positive for Covid-19 off the
building but if they did, maybe staff wouldn’t call out.” While being shorthanded has
always been a genuine concern for these workers, the burden seems to be heightened
during a national pandemic.
Outside of staff shortages, participants perceived that advancement and extrinsic
rewards such as pay and working conditions may contribute turnover. Participants
reported that, “having to wait for a pin to open to apply for a promotion sometimes run
people away”. “If they pay more, the younger people might stay longer”. “The
supervisors can run people away with the way that they talk to you”. Direct care workers
in the study also pointed out their belief that turnover rates are greater in younger
employees and for those who have been employed for under a year. One participant
stated, “I can tell when a new employee walks on the building, how long they will stay.”
It was found from the study that Herzberg’s theory of job satisfaction based on
intrinsic satisfaction can be successfully applies to this unique group of workers. Overall,
most participants seemed satisfied in the areas of recognition, achievement, and the work
64
itself. Participants took their responsibilities to both clients and co-workers very
seriously and viewed their relationships with their clients as a strong indicator of their
satisfaction and the reason why they stay. Participants perceived their work as satisfying
but most believed that if efforts to improve recognition and advancement opportunities
improved, so would their satisfaction and retention.
Limitations of the Study
The purpose of this study was to determine how intrinsic rewards affect job
satisfaction and retention among direct care workers in mental health settings. My first
limitation was the focus on direct care workers in mental health settings in a metropolitan
area of a southern state. Because this study addressed the beliefs of mental health direct
care workers, the opinion of direct care workers from other specialties may not be
generalized. Therefore, focusing on this unique population may limit the transferability
of results. The research is also limited to understanding intrinsic rewards which only
examine one aspect of Herzberg’s two-factor theory. The next limitation of this study is
that the study was conducted during a national public health crisis due to the COVID-19
pandemic. During this global epidemic, mortality rates increased worldwide including
health care settings. Participants performed their duties under more adverse working
conditions. During recruitment, interviews were delayed or postponed due to a higher
demand for workers to cover additional shifts. Participants describe the added stress they
endured due to concern of exposure to the virus, receiving adequate protective gear to
perform their duties, and having to work in close proximity of their clients when
65
performing their job duties that required hands on care. Another limitation was in the
recruitment process that was limited to posting flyers at a time when due to COVID-19,
most businesses were closed or modified their hours of operation. Also, a result of the
health crisis, face to face contact was prohibited and data collection procedures were
limited to e-mail correspondence to receive consent, and over the phone interviews. The
small sample size could also serve as a potential limitation, yet though it met the
requirements for a generic qualitative study, having more participants could
strengthening the knowledge on satisfaction and retention of direct care workers.
Recommendations
According to Espinoza (2017), the demand for direct care workers is projected to
increase from at least 5.2 million by 2024 to even further growth by the year 2030.
Challenges faced in satisfying and retaining this unique population led me to the
following recommendations. One recommendation is that future research be conducted
using extrinsic motivators and their role in the satisfaction and retention of these workers.
The information gathered in my study focused on perceptions of intrinsic rewards that
may contribute to satisfaction and retention. In addition, further research on employee
recognition could support efforts toward employee retention and satisfaction among these
workers.
Another recommendation is that future research studies should not be limited to
inclusion criteria of at least two years of employment. The average length of stay for the
participants in the study ranged from 2 years to 25 years with most participants having
66
worked an average of 15 years. Because recognition was perceived as a strong indicator
of satisfaction, another recommendation is that this aspect of intrinsic rewards be pursued
in further research to examine whether a connection exists between achievement and
recognition. The findings from this study suggest that participants believed that intrinsic
rewards such as achievement, responsibility, and the work itself enhanced their
satisfaction and motivation to stay on their jobs. However, they believed that
organizational leadership could provide improvement in the areas of advancement and
employee recognition. Sahir, Phulpoto, and Zaman (2018) said that to retain employees
long term, organizations should provide training and develop opportunities for their
employees, to generate self-achievement and growth. The data revealed that direct care
workers enhanced recognition, training, and advancement opportunities. Implementing
programs that provide for support in these areas could make a difference in the work lives
of these employees, the clients they serve, and organizational leadership.
Implications
Job satisfaction and retention is important to the success of any organization. The
findings from this study produced several implications for social change. One
implication is organizational policy as it relates to programs that provide for skills
training and development, and ways to offer advancement opportunities for these
workers. Enhancing and implementing new polices that address these changes could
have a positive impact on employees’ overall work experiences. The results of this study
can also inform mental health organizations, stakeholders, and policy makers about the
67
importance of addressing issues of satisfaction and retention that can impact the overall
success of the organizations.
Another implication for positive social change derived from this study is the need
to listen to the voices of direct care workers. Most participants shared experiences of
their relationships with their clients more so than that of their co-worker, supervisor, or
upper level administration. One participant described a time when the administrators
along with their supervisors toured the buildings and talked directly with employees and
patients. The experience was described as “meaningful and a good way to connect and
get to know the staff.” Having face to face conversations about the day to day challenges
and acknowledging employees’ viewpoints could promote a sense of autonomy within
the workforce. Because participants expressed the gratitude and value in having close
relationships with their clients, providing opportunities for social engagement with their
clients, could contribute to bonding relationships which in return may have and positive
impact on the overall work environment. It is also significant to recognize these workers
for the critical role they play in caring for their clients and ensuring safety in a
challenging work environment. Another implication of this study is that in order to
motivate direct care workers in mental health organizations, administration should find
solutions to address the needs of these workers. With that, social change may be
observed in the increase of employee and patient satisfaction and an increase in employee
retention. All participants reported that they would refer others to their organization
68
therefore, having satisfied employees could also have an impact on recruitment efforts for
the organization.
Conclusion
Previous literature on job satisfaction in mental health services has focused on
burnout and employee turnover . Current efforts to understand what satisfies direct care
workers and keep them on the job particularly in mental health settings commonly focus
on extrinsic measures such as pay, organizational leadership, and working conditions.
While understanding these factors is necessary given the low salaries and reported
burnout in these workers, understanding the impact of intrinsic motivators should also be
studied in greater length.
This present study raises many questions for future research regarding lived
experiences that lead to satisfaction and retention among mental health direct care
workers. It also adds to dearth of research on these workers and provides a foundation for
future researchers to expand the knowledge and understanding of job satisfaction and
retention in mental health settings as well as ways to create a work environment that
fosters improved satisfaction and retention among this understudied population.
The results of the study show that the presence of intrinsic factors like
achievement, responsibility, and the work itself, are perceived motivators, or indicators
that lead to satisfaction and retention. Furthermore, findings indicate that strategies
designed to improve recognition and opportunities for advancement are particularly
important ways to increase job satisfaction and retention among these workers.
69
Recurring themes expressed by the participants suggests that the greater their
autonomy, the greater their job satisfaction. While a range of job demands were
influential in the perception of what satisfied these workers, the level of care they
provided under demanding work conditions, offered these workers a sense of fulfillment
in knowing that they played an integral part in someone improving to the point of
discharge. Furthermore, providing a safe environment for co-workers and clients and
developing a bonding relationship with the client seemed to outweigh the demands of a
challenging work environment. While participants voiced their opinions of the need for
improvement in the area of growth and recognition for their hard work from supervisors
and administration, the presence of their intrinsic experiences were perceived as
fulfilling and personally satisfying to this group of workers.
Overall, contributions from this study include a better understanding of how
intrinsic motivators impact job satisfaction and retention among mental health direct care
workers. I concluded from the findings that greater attention should be paid to their
intrinsic motivation to stay committed to the job. The research shows that the demand for
these skilled workers will continue to rise, thus should efforts to satisfy and retain this
skilled group of workers. In an effort to increase their satisfaction and commitment, the
voices of these workers have called on leadership and administration to create better
growth opportunities and improve ways that acknowledge and show appreciation for their
work and dedication to the organization.
70
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Appendix A: Minnesota Satisfaction Questionnaire]
Minnesota Satisfaction Questionnaire (MSQ)* Short Form
Vocational Psychology Research
University of Minnesota
Copyright (1997)
Ask yourself: How satisfied am I with this aspect of my job?
5 = Extremely Satisfied 4 = Very Satisfied 3 = Satisfied 2 = Somewhat Satisfied 1 =
Not Satisfied
1. Being able to keep busy all the time.
2. The chance to work alone on the job.
3. The chance to do different things from time to time.
4. The chance to be “somebody” in the community.
5. The way my boss handles his/her workers.
6. The competence of my supervisor in making decisions.
7. Being able to do things that don’t go against my conscience.
8. The way my job provides for steady employment.
9. The chance to do things for other people.
10. The chance to tell people what to do.
11. The chance to do something that makes use of my abilities.
12. The way company policies are put into practice.
13. My pay and the amount of work I do.
14. The chances for advancement on this job.
15. The freedom to use my own judgment.
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16. The chance to try my own methods of doing the job.
17. The working conditions.
18. The way my co-workers get along with each other.
19. The praise I get for doing a good job.
20. The feeling of accomplishment I get from the job.
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Appendix B: Sample Questionnaire
(Job satisfaction sample questions)
1. Describe a time when you felt satisfied with your work?
2. What were the circumstances that may have contributed to your job retention?
3. What do you value most about being a direct care worker?
4. How would you categorize your experiences as a direct care worker?
5. What are your experiences with seeking advancement within your workplace?
6. What specific considerations have influenced your decision to remain in your
organization?
7. How has leadership at your organization contributed to your job satisfaction?
8. How likely are you to refer someone to work at your organization?
9. In what ways are you recognized as a valuable employee?
10. In your opinion, what could your organization do to increase your job
satisfaction?